Medical Science Department, Respiratory Medicine, Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany.
Respir Med. 2010 Jul;104(7):1012-9. doi: 10.1016/j.rmed.2010.01.005.
The Burden of Obstructive Lung Disease study showed that in Germany, to confirm the diagnosis of chronic obstructive lung disease (COPD) in one subject, eight people ≥ 40 years of age have to be screened. The number-needed-to-screen (NNS) increased to 18 for identifying a patient with COPD ≥ GOLD stage II. These high numbers limit the cost-effectiveness of COPD screening by population spirometry. We investigated in a primary care setting whether using two simple questions regarding smoking status and presence of cough and/or dyspnea may help to preselect patients for proper diagnosis of COPD.
A total of 1088 patients aged ≥ 40 yrs without a history of chronic lung disease, who were either current or ex-smokers and complained of cough and/or dyspnea, were examined by respiratory physicians. Spirometry was carried out to confirm COPD diagnosis and severity.
A total of 61.6% of patients were male. Mean smoking history was 31.8 pack-yrs. In 516 patients (47.4%), a diagnosis of COPD was confirmed. Among these, 379 (34.8% of total) had at least GOLD stage II COPD, while 89 (8.2% of total) had advanced disease (GOLD stages III/IV). COPD prevalence was significantly associated with age and the extent of cigarette smoke exposure.
Two questions regarding smoking status and presence of cough and/or dyspnea enabled general practitioners to select patients at risk for COPD for subsequent spirometry. This preselection reduced the NNS to 2.1 for identifying a COPD patient, and to 2.9 for identifying a patient of at least GOLD stage II.
《阻塞性肺病负担研究》表明，在德国，为了确诊一名慢性阻塞性肺病（COPD）患者，需要对 8 名年龄≥40 岁的人群进行筛查。如果要确诊≥GOLD Ⅱ级 COPD 患者，所需的筛查人数（NNS）增加到 18 人。这些高数字限制了人群肺量测定法进行 COPD 筛查的成本效益。我们在基层医疗机构中研究了使用两个简单的问题（关于吸烟状况以及是否存在咳嗽和/或呼吸困难）是否有助于筛选出需要进行 COPD 适当诊断的患者。
共有 1088 名年龄≥40 岁、无慢性肺病病史、目前或曾经吸烟且抱怨咳嗽和/或呼吸困难的患者接受了呼吸科医生的检查。进行肺量测定以确认 COPD 诊断和严重程度。
共有 61.6%的患者为男性。平均吸烟史为 31.8 包年。在 516 名患者（47.4%）中，确诊为 COPD。其中，379 名（占总数的 34.8%）至少患有 GOLD Ⅱ级 COPD，89 名（占总数的 8.2%）患有晚期疾病（GOLD Ⅲ/Ⅳ级）。COPD 的患病率与年龄和吸烟暴露程度显著相关。
两个关于吸烟状况和咳嗽和/或呼吸困难的问题使全科医生能够选择有 COPD 风险的患者进行后续的肺量测定。这种预选将 NNS 降低到识别 COPD 患者为 2.1，识别至少 GOLD Ⅱ级患者为 2.9。
